~ A periodic blog on matters health, union, social justice, and the occasional random rant

Monthly Archives: July 2013

As I often do, last night I tweeted facts about ramping in Victoria, as posted on the Code Red Facebook campaign page. That night, among the many crews ramped at hospitals across the state, ten were ramped at the Northern.

I’ve written about the problem of ramping before. One of the things I didn’t say last November was that ramping significantly contributes to overtime and missed breaks – paramedics can’t leave their patients just because their shift is over, even if it will be another two hours before the hospital they’re ramped at can take the patient; though they’re paid for this time, the shift extensions contribute to fatigue (which increases risks of error and accidents, as well as long term health effects and increased rate of burn out), and intrude on personal time.

Ramping is only part of the problem facing Victoria’s paramedics, who are currently in EBA negotiations with the state government – though they’re the best trained paramedics in the country, with world-beating rescue times for cardiac patients, our paramedics are the nation’s worst paid. There are virtually no return-to-work programs for paramedics injured on the job, despite suggestion from their union that placing these professionals in emergency departments (where they wouldn’t have to lift stretchers, negotiate stairs, bend to the ground and other limiting actions) would both allow the industry to retain experienced staff while also freeing ramped crews. And there are inadequate support services for the men and women who witness horrendous injuries and are subject to the highest rate of occupational violence in Victoria – a combination that sees not only a high turn over rate and distressing levels of substance abuse, but a suicide rate six times the state average.

For Victoria’s paramedics – just as was the case for Victoria’s public sector nurses and midwives – this really is a campaign that’s about fair compensation but much more than just the money.

The reason why there’s an emphasis on ramping is that it’s the aspect of service provision that most affects the public, it’s visible, and it’s undeniable. It’s the single biggest reason for delays, and some of the examples posted by paramedics are truly astonishing – like the night a category 1 call (which merits urgent attendance) in Tarneit was responded to by a crew from Prahran – because there were no available crews in the west or north of Melbourne.

There have already been cases were delays appear to have affected patient outcomes, and it seems inevitable that people will die. The Victorian government, though talking about commitment to health care, has failed to move with any swiftness, and the only way to put prssure on Premier Napthine and Health Minister Davis is through public attention – paramedics cannot reduce services, as we did.

Which is why I tweet about ramping – because the more the public understand about why this is important, what it means, and how we are all potentially affected,t he more able they are to support our paramedics. And make no mistake – this is an issue that can affect anyone who lives or visits Victoria, because you never know when the patient on that stretcher may be you or someone you love.

Which brings me back to Monday.

As I tweet, ten ambulance crews are ramped at the Northern hospital alone – we have a crisis, Premier Napthine: please help! #SpringSt

In response to my tweet, someone I didn’t know replied “they are… walk outside and have a look behind the temp fencing… new ED bays. #springst”

We then proceeded to have a very frustrating discussion, where he insisted that the problem was “purely capacity” of emergency departments, and where I was informed that “general [inpatient units] can swing for maternity or surgical etc… ED bays are specialised” (and later “highly specialised”).

I agree that emergency medicine is a specialty – I certainly couldn’t practice with the same level of proficiency there as I do on my specialist medical ward. The focus of ED is assessment, initial treatment, and flow – to outpatients, home, or specialist wards. Staff there deal with every conceivable condition, from splinters to myocardial infarction, from fractured toes to major traumas. They never know what’s coming thorough the door next, their patients are often drug and/or alcohol affected, they don’t conveniently arrive with a medical, psychiatric and social history attached, and both the patients and their accompanying entourage of friends and family are often emotionally volatile.

I find the statement that inpatient units are not equally specialised both insulting and ill-informed. When I pointed out that my position was informed by almost a quarter of a century working at a tertiary hospital (including some time in one of the state’s busiest emergency departments, albeit some time ago), I was informed that his position “is informed by a decade of health conferences, design, user, construction meetings while building them..”

There’s a limit to how productive a discussion one can have on Twitter, particularly when it’s being approached from very different perspectives. We ended with his reiterating that some hospitals are having ED capacity added, and me tweeting “I appreciate that. My point is that ramping, and ambo issues in general, are about more than bed/ED capacity”

And then I had a little rant of Facebook. It was well received there, so I’m reproducing a slightly expurgated version here.

Ambulance ramping is, indeed, a multifactorial problem. When I tweeted that there were ten ambulances ramped at the Northern, it was part of a number of tweets, over a number of weeks, about ramping across the state.

How awesome the Northern’s extending its ED. That doesn’t invalidate my points, that:
a) more nurses in ED would reduce ramping
b) the Vic govt declined that, as it would be a nursing budget cost but a paramedic productivity gain
c) we have too few paramedics
d) Vic paramedics are very highly educated, and appallingly paid
e) they have inadequate supports, almost no return-to-work systems, and woefully inadequate safety measures
f) your decade “attending health conferences, design, user, construction meetings while building them” is awesome, but doesn’t outweigh twenty-four years working on the damn floor, including ED
g) especially when you tweet that in-patient units aren’t specialised, and give the examples of them bring able to take surgical patients and MATERNITY!
h) then say ED is more specialised

If you think any area of nursing’s not specialised, it’s because you don’t know what you’re talking about – from mid to aged care, ICU to palliative care, plastics to orthopaedics, for the best outcome you want nurses, midwives, doctors, surgeons, pharmacists and allied health staff who know more about that area that anything else.

A renal-experienced pharmacist would have prevented an accidental overdose of one of our patients – prescribed by a doctor who didn’t know the condition or protocols, and missed by busy nurses, this is just one example of how specialised experience makes a difference.

Finally – I don’t know nothing ’bout birthin’ no babies – don’t tell me maternity’s not a specialty! Sure, we can care for patients in specialties other than our own, but we’re more likely to miss things. You wouldn’t see a paediatrician about a detached retina – don’t think a nurse is a nurse is a nurse!

I know this has turned into a rant about nursing, for which I won’t apologise, because it’s important and something too many people (including those who should know better) fail to recognise. But I will conclude where I began, with paramedics.

Two weeks ago I attended the Australian Nursing and Midwifery Federation (Vic. branch)’s annual delegtes conference for job representatives – it’s an opportunity to learn, network, strategise, and propose the resolutions which form the basis for our log of claims at every Enterprise Bargaining Agreement negotiation.

This year one of the most interesting presentations, in a highly competitive field, was about the use of social media by health care staff, and the presentation caused me to reflect on the growing presence of soocial media, and what that may mean for us.

Certainly the ANF’s Facebook page was a significant component of our success in the 2011/12 campaign, in terms of connectedness, morale and communication – as discussed in this interesting article in Business Spectator. There is, however, a lot of concern about health professionals – particularly nurses and midwives – using social media. There’s no question that, both in our profession and across other industries, people have lost jobs, careers, reputations and relationships over ill-considered social media use.

In consequence, there are some who advise nurses and midwives to avoid social media use altogether – or to use pseudonyms. Quite clearly that’s not my position – Iuse my own name here and on Twitter, and though I don’t advertise my workplace, it’s easily found on a Google search.

I believe that social media is increasingly a part of our lives – from the prominent platforms, like Facebook, to applications you may not think of as social media, like Pinterest, blogs, websites like AllNurses, and even comments on digital articles. We need to embrace and utilise it, not fear and avoid it.

Nursing and midwifery are professions that encompass an enormous variety of populations – some, like myself, utilise multiple social media platforms, while others check email once a week and that’s it. Most of us, though, fall somewhere in the middle – perhaps a Facebook account and a LinkedIn profile, for example.

Social media can be a valuable tool – Facebook and MySpace help maintain relationships with friends and former colleagues; Twitter is a great source of news and activism; LinkedIn can help you develop a professional network and generate job offers; Academia does the same thing for higher degree students and academics; blogs allow you to share your opinions, often with like-minded people; while YouTube, Pinterest, Tumblr and Vimeo can be valuable sources of information, but also eat vast chunks of time!

However, an increasing number of employees, including health professionals, are finding themselves in disciplinary action over inappropriate use of social media. These range from derogatory remarks about a supervisor, to action that could lead to deregistration, including inappropriate relationships with patients and breaches of confidentiality.

The first thing is to check your privacy settings – who has access to your posts or data? On Facebook you can check what a stranger, or any specific friend can see – if you click on the padlock icon, then “who can see my stuff?” the option View As comes up. This shows you what your page looks like to someone you haven’t friended.

However strong your privacy settings are (and with Facebook they’re frequently reset, often without notice), anyone you’re friends with can take a screenshot of your page. Or, as I was reminded while I was typing this, by sharing your post – I don’t swear on publicly-accessible social media but I do on my own Facebook page, and fifteen minutes ago a friend reposted something I’d written that was more sweary than I’d like out in the general domain.

However, I don’t ever write anything that I wouldn’t be okay with being made public. I’ve certainly written things in private messages that would be personally embarassing if they were made public – but nothing that would embarass my employer, any organisation with which I was affiliated (like my university or my union), or anything that breaches my duty of confidentiality. Because even if you delete a post, nothing’s really gone once it’s sent out into the world.

I try to live my life with integrity, and I firmly believe that my online interactions shouldn’t be separate from that – social media is a part of my life, not an entity separate from it. It seems to me this is rarely the way social media is viewed, however – particularly when organisations draft policy.

Nurses and midwives have at least two policies that their social media use may be held up against – their employer’s, and the Australian Health Practitioner Regulation Agency’s. The former tends to deal with patient and organisational confidentiality; the latter is significantly restrictive, has been broadly criticised, and is back in review – I found the most useful discussions about AHPRA’s draft policy were by Ian Miller at ImpactedNurse, and Melissa Sweet on Croakey (the health sub-section of Crikey). In addition, I strongly recommend reading the ANMF Vic. Branch’s advice.

What safe social media use boils down to, though, is using common sense: don’t do anything online that is unprofessional or that you would be embarrassed to have made public.

On the most obvious front that includes measures to safeguard the public – don’t post photos from work that show you acting unprofessionally; don’t post identifiable information about a patient, staff member or family member (this is particularly a problem in rural workplaces, but is an issue across the board – and wherever you work, even if you don’t identify your workplace in that post, it may be clear from other posts, or your profile); don’t post photos of patients.

The second layer of caution concerns how you portray your own professionalism: don’t post if you’re on sick leave; be cautious about posts that, though not at work, may lead to speculation about your reliability – tht reference recreational drug use, for example. Be aware that posting a status about how drunk you are at 2AM may be a problem if your make an error during a morning shift six hours later. And recognise that employers increasingly Google potential staff, often prior to interview. Try putting your name into a search engine – you may be surprised by what comes up!

Finally, remember that digital photos contain metadata – when the photo was taken and, with newer technology, where. This has caused disciplinary issues for staff who’ve called in sick for work, then posted photographs of themselves during that time – even if the post was made some time afterward.

All of that can make it sound as though nurses and midwives really should avoid social media! But it boils down, as I said, to using common sense – if you’re not sure whether or not to post something, wait.

Here’s what I’ve gained, after only using social media as a tool for about eighteen months:

I became heavily involved in the ANF (Vic. branch)’s EBA campaign, which has made me recognisable to nurses across the state

as a result of my interactions on the Respect Our Work page I developed a reputation for dispassion, advice and reliable information

posts on that page formed the foundation for this blog, which is now being archived by the National Library

I became known to staff and officials of the ANF, which contributed to being selected for the Anna Stewart Memorial Project at Trades Hall

that program, combined with union activism on Facebook, Twitter and at events has resulted in a soicial media role with VTHC for a project next year

I was asked to represent ANF when our NSW colleagues launched their EBA campaign earlier this year

I was voted, along with 21 other delegates, to represent Victoria at the ANMF bi-annual Federal conference later this yearÍ’m running for ANF (Vic.) branch council

one of the people I met through Twitter has asked me to give clinical advice of a patient dependency modelling system he’s co-developing for interstate application

I’ve been nominated for a social media award

I have over 1500 followers on Twitter

I’ve had five tweets broadcast during the program Q and A

I’ve been able to disseminate petitions, questions and information to a far wider audience than I could ever otherwise reach

I know people across professions, industries and around the world I’ve never have otherwise been in touch with – like a plenary speaker fromt he UK coming out for a conference later this year

I’ve met people who have already changed my life…

and at the beginning I wasn’t even aware that’s what I was doing!

Social media is a valuable tool that can enhance both your personal and professional lives.It can allow you seek, and share information at an amazing pace; it can allow you to become informed about issues you knew little about; it can connect you with like-minded people, and intriduce you to ways of thinking wholly alien to your own.

But it is a double-edged sword that should be used with caution. Remember than nothing is really private, and no account is really anonymous. If you wouldn’t say something publicly, you shouldn’t broadcast it electronically – and you can be in both professional and legal trouble for things you publish or re-publish electronically, including libellous or defamatory statements.

Provided you can keep those caveats in mind, social media has the capacity to enhance your life – while siphoning awy hours of it!
I am indebted to fellow nurses and enthusiastic supporters of social media Paul McNamara (whose recently wrote on nursing and social media), and Damien Hurrell for a brief but useful exchange earlier today – the hypertext links go through to their Twitter accounts, if you’re looking for great people to follow.